Presentation Transcript

1. Affordable Care and Payment Reform: The Impact on Health IT

   Rep. Gayle Harrell Florida House of Representatives Member of the Health Information Technology Policy Committee @SpeakerHandle | #GovHIT DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
2. Health Information Policy Committee Established under American Recovery and Reinvestment Act 2009 (ARRA 2009) A Federal Advisor Committee Membership The Health IT Policy Committee is comprised of: 3 individuals appointed by the Secretary of HHS 13 members appointed by the Acting Comptroller General of the United States 4 members appointed by the Majority and Minority Leaders of the Senate and the Speaker and Minority Leader of the House of Representatives Additional Federal members appointed by the President @SpeakerHandle | #GovHIT
3. Committee Members Karen DeSalvo, Chair, ONC Paul Tang, Vice Chair, Palo Alto Medical Foundation David W. Bates, Member, Brigham and Women's Hospital Christine Bechtel, Member, National Partnership for Women & Families Paul Egerman, Member, Software Entrepreneur Scott Gottlieb, Member, American Enterprise Institute Gayle B. Harrell, Member, Florida State House of Representatives Charles Kennedy, Member, Aetna/WellPoint, Inc. David Kotz, Member, Dartmouth College David Lansky, Member, Pacific Business Group on Health Christoph Lehmann, Member, Vanderbilt School of Medicine Devin Mann, Member, Boston University Deven McGraw, Member, Manatt, Phelps & Phillips, LLP Aury Nagy, Member, Las Vegas Neurosurgery & Spine Care Neal Patterson, Member, Cerner Marc Probst, Member, Intermountain Healthcare Kim Schofield, Member, Lupus Foundation of America Troy Seagondollar, Member, United Nurses Association of California Joshua M. Sharfstein, Member, State of Maryland Alicia Staley, Member, Tufts Medical Center Patient & Family Advisory Council MadhulikaAgarwal, Ex Officio, Department of Veterans Affairs Patrick Conway, Ex Officio, Centers for Medicare & Medicaid Services Thomas W. Greig, Ex Officio, Department of Defense Chesley Richards, Ex Officio, Centers for Disease Control and Prevention Robert Tagalicod, Ex Officio, Centers for Medicare & Medicaid Services
4. HITECH Incentive Program ARRA 2009 $20 Billion allocated to individual physician (non hospital based) incentives to purchase qualified EHR’s that meet Meaningful Use criteria Are certified Report specific criteria to CMS Based on amount of billable charges for Medicare billed through EHR’s Maximum of $44,000 per physicians over 5 year period if adopt before December 31, 2012 Incentives began in January 2011 Penalties begin in 2015 Now in 4rd year of program
5. Patient Protection and Affordable Care Act PPACA AKA Affordable Care Act (ACA) or "Obamacare” Signed into law by President Barack Obama on March 23, 2010 Focuses on new service delivery and payment models Greater coordination of care and improved quality. Restructuring Medicare reimbursements from fee-for-service to bundled payments. Pay for Performance Clinical Quality Measures Medicare Shared Savings program (MSSP), Accountable Care Organizations (ACO’s) The Patient-Centered Medical Home (PCMH)
6. Accountable Care Organizations ACO’s Provider-led organizations with a strong base of primary care Collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients Accept responsibility for a defined group of Medicare Fee-For-Services (FFS) beneficiaries Share in savings or loss Payments linked to quality improvements that also reduce overall costs Reliable and progressively more sophisticated performance measurement to support improvement and provide confidence that savings are achieved through improvements in care. CQM!
7. Patient Centered Medical Home Promote comprehensive, coordinated, patient-centered care Delivered by teams of primary care providers, including physicians and nurses. Primary care provider and members of his or her team coordinates all of a patient's health needs: including management of chronic conditions visits to specialists hospital admissions reminding patients when they need check-ups and tests. supports fundamental changes in primary care service delivery and payment reforms, with the goal of improving health care quality.
8. Affordable Care and Payment Reform: The Impact on Health IT? Is it really possible to ensure access to quality healthcare and reduce cost and the same time?? HMO’s? PPO’s ACO’s? MCMH? Bundled Payments? P4P?
9. What is the Impact on Health IT? What is the Impact of Health IT? Quality __________ = Value Cost
10. Anthem Blue Cross and Torrance partner with Calif.-based HealthCare Partners: $4.7 million in savings for the first six months of 2013 compared with a similar patient pool, the organizations say. Improved utilization metrics: reduced hospital admissions and inpatient days, fewer emergency room visits, and reduced laboratory and radiology tests. Improved quality measures in preventive health screenings and management of acute and chronic disease as measured by HEDIS. Improvements in HEDIS benchmarks included:Hospital Inpatient Days, -18% Inpatient Admits, -4% Outpatient Visits (including ER visits), -4% Radiology Visits, -4% Lab Visits, -4% Professional Visits, -2% What is the Impact of Health IT?ACO: Health Care Partners
11. Health IT Strategic Framework Vision “A learning health system that is patient-centered and uses information to continuously improve health and health care of individuals and the population.” Goal: Learning Health System 1: Meaningful Use of Health Information Technology 2: Policy and Technical Infrastructure 3: Privacy and Security 11
12. Bending the Curve Towards a 21st Century Transformed Healthcare System Achieving Meaningful Use of Health Data “These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth” “Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.” Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009
13. Bending the Curve Towards a 21st Century Transformed Healthcare System Ultimate vision is to enable significant and measurable improvements in population health through a transformed health care delivery system. Key goals*: Improve quality, safety, & efficiency Engage patients & their families Improve care coordination Improve population and public health; reduce disparities Ensure privacy and security protections *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008
14. Bending the Curve Towards a 21st Century Transformed Healthcare System 2009 2011 2013 2015 HIT-Enabled Health Reform Meaningful Use Criteria HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) 14
15. Active Registrations – April 2014 Active Registrations
16. EHR Incentive Programs – May 2014 Total Payments Total of over $24 Billion Incentive Programs
17. April – By the Numbers April – By the Numbers
18. April – By the Numbers April – By the Numbers
19. April – By the Numbers April – By the Numbers
20. April – By the Numbers April – By the Numbers
21. EHR Incentive Program Trends Incentive Program Trends Over 91% of eligible hospitals have received an EHR incentive payment for either MU or AIU 88% of eligible professionals have registered for the Medicare or Medicaid EHR Incentive Programs 68% of Medicare and Medicaid EPs have made a financial commitment to implementing an EHR Over 380,000 Medicare and Medicaid EPs have received an EHR incentive payment
22. Achieving Meaningful Use
23. Meaningful Use Stage 1 SummaryData Capture EPs 25 Objectives and Measures 8 Measures require ‘Yes’ or ‘No’ as structured data 17 Measures require numerator and denominator Eligible Hospitals and CAHs 23 Objectives and Measures 10 Measures require ‘Yes’ or ‘No’ as structured data 13 Measures require numerator and denominator Reporting Period – 90 days for first year; one year subsequently Focus on Data Collection and Process
24. Stage 2 Escalator to Stage 3: Advanced Care Processes Data Capture & Sharing Add in key elements of NQS/delivery system reforms
25. Many Stage 1 objectives must be achieved at higher percentages and for higher percentage of patients New requirements: CPOE for laboratory and radiology orders; VDT - ability of patients to view, download and transmit their health information; Public health reporting to cancer registries and other specialized registries. Summary Stage 2 Meaningful Use
26. Transitions of Care: EP or EH transitioning or referral provide a Summary of Care document for 65 percent of patients. Must be electronically transmitted with both the sender and receiver using certified EHRs, 10 percent of transitions of care and referrals, the recipient must have no organizational affiliation with the sender and be using a different EHR vendor than the sender. Stage 2 Meaningful Use
27. Decision Support – Expanded Role Expansion of not just USE of decision support but ensure proper interventions are taken. For instance, an alert could be issued when a physician in a group practice is seeing a patient with a large body mass index, recommending the patient is sent to the dietician following the office visit. Requires comprehensive decision support incorporated into an EHR, configuring it with lab results, problem and medication lists, and other health status indicators, and presented at relevant points in the workflow Stage 2 Meaningful Use
28. CPOE: Stage 1 requires the licensed professional whose judgment creates the order (the physician) must personally use the CPOE function. (Physicians want to be caregivers and not documenters.) Demographic Data: Capturing demographic information as structured data increase from 50 percent to 80 percent. Patient Engagement: EP’s - 50 percent of patients have the ability to view online, download and transmit their health information within four business days EH:10 percent of patients actually have to view, download or transmit. Patient preferences for being contacted recorded 20 percent of patients. Stage 2 Meaningful Use
29. Stage 2 Meaningful Use Clinical Quality Measures: CQMs are no longer a meaningful use core objective Reporting CQMs is still a requirement for meaningful use Essential element of payment reform and ACA
30. Stage 3 Meaningful Use Principles Guiding Supports new model of care (e.g., team-based, outcomes-oriented, population management) Addresses national health priorities (e.g., NQS, Million Hearts) Broad applicability(since MU is a floor) Provider specialties (e.g., primary care, specialty care) Patient health needs Areas of the country Promotes advancement -- Not "topped out" or not already driven by market forces Achievable-- mature standards widely adopted or could be widely adopted by 2016
31. Stage 3 Meaningful Use Stage 3 focuses on outcomes Link MU3 to HHS initiatives (e.g. NQS, Million Hearts) Link MU3 to future payment models (e.g., ACO, MSSP) Reducing disparities
32. Stage 3 - Aligning Meaningful Use New Models of Care and Payment Accountable care Supporting population management Longitudinal data and shared care plans across the continuum, including wellness Supporting new payment models Medicare Shared Saving Program requirements
33. Stage 3 - Influencing Health OutcomesInterlocking HIT Functions and Provider Behavior
34. Stage 3 Meaningful Use Health Information Exchange: Key Component of Stage 3: Care Coordination: sharing care summaries and care plans, Depends on health information exchange
35. Exchanging Data: Key to Cost Containment More than 40 percent of outpatient visits involve a transition Almost three quarters of the time (73 percent) PCPs do not get discharge info within two days. Almost always sent by paper or fax Referring physicians receive feedback from consultants only 55 percent of time Physicians make purpose of referral clear 74 percent of time 1 in 5 discharged Medicare enrollees is readmitted with a month
36. How do we achieve interoperable healthcare information systems? Enablestakeholdersto come up with simple, shared solutions to common information exchange challenges Curate a portfolio of standards, services, and policies that accelerate information exchange Team convened to solve problem Accuracy & Compliance Solutions& Usability Enforce compliance with validated information exchange standards, services and policies to assure interoperability between validated systems
37. EXCHANGING PATIENT DATA Authentication / certificates Trust Relationships Delivery Protocols Security Directories Vocabulary/ Document/ Message Standards
38. HIE (the verb) comes in many shapes and sizes National level collaborative HIE organizations State-level and regional collaborative HIE organizations Enterprise-level HIE organizations Level of external coordination needed Transaction-specific national level Vendor-specific Point-to-point Point-to-patient
39. Jason Report on Health Information Exchange Sponsored by AHRQ in collaboration with ONC and the Robert Wood Johnson Foundation JASON is an independent scientific group that provides consulting services to the US government on matters of science and technology. It was established in 1959.
40. Study Charge How can complex data handling techniques and Internet-based technologies be applied to health care to promote the development of real-time integrated datasets at a scale seen in other industries? How can the various users of health data in the clinical research and public health communities be presented with tailored and highly specific data views in near real time based on routinely collected health data? As health data grows from megabits to gigabits per individual, what fine-grained analytics should be made available to patients and health care providers to guide health care decisions? What fundamental data management capabilities are needed to support potential future requirements in an open-ended manner? What are the national security consequences of not addressing comprehensive health data opportunities in clinical research and public health?
41. Briefing Organizations
42. Challenges identified Federation Jurisdiction Scalability User interface Interdisciplinary Front loaded cost Payer Business Model Exchange concept Data security Data integrity Access and curation Consent Intellectual property Legal liability
43. Key Findings The current lack of interoperability among data resources for EHRs is a major impediment to the unencumbered exchange of health information and the development of a robust health data infrastructure. Interoperability issues can be resolved only by establishing a comprehensive, transparent, and overarching software architecture for health information. The twin goals of improved health care and lowered health care costs will be realized only if health-related data can be used in the public interest, for both clinical practice and biomedical research. That will require implementing technical solutions that both protect patient privacy and enable data integration across patients.
44. Meaningful Use CEHRT NPRM
45. About the NPRM About the NPRM CMS and ONC NPRM published on May 20 proposing 2014 CEHRT flexibility and extension of Stage 2 If finalized, the NPRM would: Allow providers to meet meaningful use with EHRs certified to the 2011 or the Edition criteria, or a combination of both Editions in 2014 Require providers to report using 2014 Edition CEHRT for 2015 EHR Reporting Period Extend Stage 2 through 2016
46. Proposed Options: Stage 1 Proposed Options : Stage 1 Proposed options for providers scheduled to meet Stage 1 in 2014
47. Proposed Options: Stage 2 Proposed options for providers scheduled to meet Stage 2 in 2014
48. NPRM Comments NPRM Comments CMS and ONC now accepting public comment: Submit online through Regulations.gov: http://www.regulations.gov/#!submitComment;D=CMS-2014-0064-0002 Deadline: July 21, 2014
49. Affordable Care and Payment Reform: The Impact on Health IT EHR +HIE +MC+PA =IO + RC Electronic Health Records + Health Information Exchange + Managing Care + Predictive Analysis = Improved Outcomes + Reduced Costs
50. Questions?Thank You! @SpeakerHandle | #GovHIT